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Retinopathy screening slated for Nov. 18 by Heather Woolwine Public Relations Diabetic patients must not only treat their condition, but also consider the damage diabetes inflicts on the body. Often that damage can be contained, if caught early. Such is the case with diabetic retinopathy.   Ten years ago, the Storm Eye Institute’s Carolyn Cavanaugh, R.N., M. Edward Wilson, M.D., now chairman of ophthalmology, and Lowery King, M.D., then SC co-coordinator of the Diabetes 2000 Project, began diabetic retinopathy screenings because “not one more person should go blind because they did not know.”   Now with the help of new-to-MUSC retinal specialist Esther Bowie, M.D., this year’s screening will be held Nov. 18 by appointment only. The screening is free for those with diabetes who have not seen an eye doctor or had a dialated eye exam in more than a year. Call 792-1414 for more information.   Diabetic retinopathy describes vision loss that can cause complete blindness. Fortunately, with laser treatment at the right time, studies indicate that about 90 percent of what could be very serious vision loss can be saved. Research also indicates that with better control of blood sugar levels, blood pressure and cholesterol, there is less chance of developing diabetic retinopathy. And, when the disorder does occur, those who have maintained better control have less severe symptoms and may require less extensive treatment.   Early detection and treatment of diabetic retinopathy is one of the keys to preventing blindness. Regular eye examinations are extremely important to prevent or curb the damage that can occur.    “Unfortunately, many people with diabetes do not understand the need to have a dilated eye exam every year when they still continue to see well,” Cavanaugh said. “Yet diabetic retinopathy could be affecting their eyes, very often with no visual symptoms at first. Usually by the time vision is affected, the disease has progressed. With early detection and early treatment, so much sight can be saved. Ten years ago, a particular patient convinced me that something has to be done. There was a real need for community education about diabetic retinopathy.”    The first diabetic retinopathy screening was a successful endeavor, and Cavanaugh credits teamwork among Storm Eye physicians and nurses, residents, volunteers, MUSC Marketing department, Health Connection, and MUSC Public Relations.   “There was immediate support for diabetic retinopathy screening. We both (Cavanaugh and Wilson) realized that our primary goal, one that we both felt very strongly about, was the prevention of blindness from diabetic retinopathy and we formed a team effort to raise awareness of preventable blindness,” Cavanaugh said.   Since that first screening, the Storm Eye Institute provides a free eye exam for people with diabetes who have not seen an ophthalmologist in more than a year. These participants also receive patient education materials, watch a diabetic retinopathy video, and have the opportunity for personal patient education from the patient educator. Each year, people with diabetes have been identified with diabetic retinopathy and other eye disorders. Those participants found with eye diseases are referred for follow-up and treatment.   “The associated awareness of preventable blindness diabetic retinopathy project has grown over the years, and community education has reached hundred thousands of people each year,” Cavanaugh said. “Over the years many ophthalmologists in our state, pharmacists, especially College of Pharmacy's Ronald Nickel, Ph.D., the Diabetes Initiative of South Carolina, primary care providers, nursing associations, parish nurses, church leaders, ophthalmic technicians, health care providers, etc., have all become involved. Everyone brings valuable information to people with diabetes about saving sight and preserving vision. Through ever evolving efforts, the professional and community education about the need for dilated eye exams has gone from local, to state, to national, and even internationally involving and encouraging other health care providers to raise the level of awareness of diabetic retinopathy.”   Diabetic retinopathy is the most common cause of vision loss resulting from diabetes. High levels of glucose in the blood damage blood vessels over time. The blood vessels at the back of the eye, where the light-sensitive retina is located, are especially vulnerable. Left untreated, the condition can result in vision loss and blindness.   There are two major types of retinopathy: nonproliferative and proliferative. The earliest phase of the disease, nonproliferative, is the most common and mildest form.  In this phase, blood vessels in the retina become weakened and leak, forming small, dot-like hemorrhages. These leaking vessels often lead to swelling or edema in the retina and decreased vision. It usually has no effect on vision and requires no treatment. But if detected, patients need to have regular checkups to monitor the condition.   The next stage is the more serious proliferative diabetic retinopathy. Circulation problems cause blood vessels in the retina to close off. New, fragile vessels develop as the circulatory system attempts to maintain oxygen levels within the retina. These delicate vessels leak easily and can also cause scar tissue to form. When blood leaks into the retina, it causes spots or floaters, along with decreased vision. Continued abnormal vessel growth and scar tissue may cause serious problems such as vitreous hemorrhage retinal detachment and glaucoma.   While diabetic retinopathy cannot be prevented, the risk can be reduced and effects lessened by controlling blood sugars, cholesterol, and blood pressure; stopping tobacco use; and having regular eye examinations.   When damage does occur, effective treatments are available. Strides in scatter photocoagulation, focal photocoagulation, and vitrectomy prevent blindness in most people. The earlier retinopathy is diagnosed, the more likely these treatments will be successful.   Laser surgery minimizes the impact of diabetic macular edema, a condition characterized by blurry, filmy vision and caused by leaking, damaged blood vessels in the retina. This laser treatment limits further vision loss and can even improve vision. Laser surgery is also important in proliferative diabetic retinopathy, as it can shrink blood vessels, or cause them to disappear.   One patient can change everything by Carolyn Cavanaugh, R.N. Storm Eye Institute Something good comes from everything, my grandmother used to say.   Somehow, before a lovely 85-year-old lady came into our clinic, this was a hard concept to understand. We all have a patient whose plight touches our hearts so deeply that we stop, look, think, and then change the direction of our path.   Mine was a beautiful, congenial, spiritual, elderly African-American woman. I liked her immediately. Little did I know when I first met her that she would impact my life forever.   As we walked down the hall to the screening room I asked, “How are you doing?” I had given her my arm since she was walking very slowly. She replied, “Oh, I can’t get around outside the house any more, but I can still get around inside my house, thank the Lord.”   I thought she was talking about the arthritis in her legs. I helped her to the chair to check her vision. She communicated that her sight had gone down. She had an old record in which the last visual acuity was 20/50. In the process of obtaining her visual acuity, I kept going further up the eye chart. She could not even see the big 20/400 “E” with either eye. When I asked her how long her sight had been down, she replied, “Quite some time now.”   Her mother had gone blind, and she probably accepted blindness as an inevitable result of her diabetes. It was clear, as I gently conversed with her, that she was unaware that blindness from diabetic retinopathy was preventable if detected and treated early.   The plight of this woman touched my heart so much, and the real need for patient education about preventable blindness for people with diabetes became very apparent to me. This patient’s situation gave birth to the diabetic retinopathy project.   Maybe my grandmother was right after all. Friday, Nov. 11, 2005 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.